Decrease in provision of alcohol screening following reduced financial incentives for GPs

A first-of-its kind, large-scale study has determined that when financial incentives for general practitioners (GPs) to talk to patients about their drinking were halted in 2015, rates of high-risk patient alcohol screening and advice provision decreased immediately.

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In April 2008, in response to poor rates of alcohol screening for high-risk patients in the UK, the Department of Health and Social Care (London, UK) introduced an alcohol directed enhanced service (DES) that provided financial incentives to encourage general practitioners (GPs) to engage more with patients concerning alcohol consumption. In 2015, these incentives were halted. In a new study, researchers have determined that following this 2015 policy change, GPs provision of alcohol advice and rates of patient screening for alcohol abuse plummeted.

The National Institute for Health Research-funded study represents the first, large-scale study to evaluate the impacts of employing short-term financial incentives to influence GP practices.

In the study, a team of researchers from Newcastle University, The University of Sheffield and University College London (all UK), analzed data from The Health Improvement Network – an electronic dataset, broadly representative of the national population, containing records on more than 4 million newly registered patients at over 500 general practices – between 2006 and 2016.

What is high-risk alcohol screening?

Researchers observed that, following the introduction of the financial incentives scheme in 2008, the percentage of patients who received high-risk alcohol screening did not  significantly increase compared to prior to 2008.

However, following scheme introduction, the proportion of patients who tested positive from screening and received brief GP advice concerning their drinking rose by 20.15 per 1000 per month.

Since halting the scheme in 2015, the rate of patient alcohol screening has dropped by close to three patients per month and the provision of advice for screen-positive patients has plummeted by 18.33 per 1000 patients per month.

Amy O'Donnell, lead study author from Newcastle University, commented: “Scaling-up our findings to the English population, we estimate that by the end of 2016 alone, 27,000 fewer patients received brief advice as a result of terminating the alcohol incentive scheme. This is despite the fact that GPs are still legally obliged to identify and support higher-risk drinkers.”

O’Donnell concluded: “As well as drawing attention to the disappointing rates of alcohol advice giving in England since GP payments were withdrawn, our findings also highlight the real risks of using short-term financial incentives to boost delivery of public health measures in healthcare.”


O’Donnell A, Angus C, Hanratty B, Hamilton FL, Petersen I, Kaner E. Impact of the introduction and withdrawal of financial incentives on the delivery of alcohol screening and brief advice in English primary health care: an interrupted time–series analysis. Addiction. doi:10.1111/add.14778 (2019) (Epub ahead of print);

What is high-risk alcohol screening?

High-risk alcohol screening is a method used by GPs to determine if a patient may require advice or counseling regarding their alcohol consumption. Validated screening questionnaires such as the Alcohol Use Disorders Identification Test (AUDIT) and the Fast Alcohol Screening Test (FAST) are employed.

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Ilana Landau

Assistant Editor, Future Science Group

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